Objective:

To assess the association between gout and ischemic stroke risk in patients with atrial fibrillation (AF).

Approach:

• Study Design: Nationwide cohort study analyzing data from the Finnish Anticoagulation in Atrial Fibrillation (FinACAF) registry, involving 229,565 patients with new-onset AF from 2007 to 2018.
• Patient Population: Among the cohort, 6,910 patients had a history of gout.
• Follow-Up: Mean follow-up duration was 4 years.

Key Findings:

• Patients with gout had a 12% higher rate of ischemic stroke compared to those without gout after adjusting for demographic and clinical factors.
• During periods without oral anticoagulation, gout was associated with a 26% higher stroke rate.
• Patients with gout documented during hospital care had higher stroke rates than those whose gout was documented only in primary care.
• Urate-lowering therapy (allopurinol or febuxostat) was associated with a 30% lower stroke rate among patients with gout.
• Stroke rates among patients receiving urate-lowering therapy were comparable to those in patients without gout.

Interpretation:

Limitations:

• The observational study design cannot establish causality.
• Data were unavailable for several potentially relevant variables, including serum urate levels and smoking status.
• Medication exposure was determined from pharmacy claims data rather than confirmed use, leading to potential residual confounding.

Conclusion:

Sources:

• Stroke (American Heart Association)